2010 Pre-Class Reading Medical Report The Hot Spotters Can we lower medical costs by giving the neediest patients better care? by Atul Gawande January 24, 2011Atul Gawande
Health-care-reform law Extra-monthly payment for the outliers Keep the saving if total costs fall >5% If fail to decline, return the monthly payment!
คลิกเพื่อแก้ไขลักษณะของข้อความต้นแบบ ระดับที่สอง ระดับที่สาม ระดับที่สี่ ระดับที่ห้า Every country in the world is battling the rising cost of health care.
Global Health Delivery Class Discussion Bangladesh NGO The Coartem Challenge Rwanda Health System Treating Malnutrition in Haiti with Ready-to-Use Therapeutic Foods Multi-Drug Resistant Tuberculosis Treatment in Peru Botswana’s Program in Preventing Mother-to Child HIV Transmission The AIDS Support Organization (TASO) of Uganda The Academic Model for the Prevention and Treatment of HIV/AIDS
Common Principle Know it’s “ scope” and it’s “component” very well
Harvard School of Public Health Core curriculum credits Biostatistics5 Epidemiology2.5 Environmental Health2.5 Health service2.5 Social2.5 Ethics2.5
Childress et al.’s model 1. Effectiveness 2. Proportionality 3. Necessity 4. Least infringement 5. Public justification
The Case of HPV Vaccine 9,710 new cases and 3,700 deaths in the US in 2006 Annual treatment cost is approximately $1.7 billion
Screening PAP smear A drop of almost 50% in the death rate between 1982 and 2002.
Cervical cancer mortality in England and Wales in women younger than 35 years rose three-fold from 1967 to Since national screening was started in 1988, this rising trend has been reversed. Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004; 364:249. Effect of PAP on incidence of and mortality from cancer of cervix in England
A proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV A vaccine that protects against HPV FDA approved in 2006 For girls age year old
A proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV Debate over mandates - Public health imperatives v.s. Personal autonomy - Possible interference with the sexual attitudes of families
Autonomy The right of individuals to govern their own behavior Necessary to be free from outside influences and limitations (Liberty) To have the ability to comprehend the action to be taken, the alternatives, and the consequences. (competence to make decision)
How to discuss sexual issues with children?
Government Law enforcement Beneficence (to act for the benefit of others) Paternalism Utilitarianism (to prevent the harm to society) Justice (fair system allocating) Nonmaleficence (against inflicting harm on others)
Herd immunity Require a sufficient number of susceptible individuals to maintain their presence Sufficient proportion of the population vaccinated